Did you know that most rejected claims are often due to a simple error? To ensure TRICARE claims are
processed correctly the first time, follow these easy tips:

• Use the correct Social Security number (SSN). An incorrect SSN will likely cause a claim to be denied. TRICARE requires use of the sponsor’s SSN. The exception is for a benefi ciary who is a TRICARE-eligible former spouse of the sponsor. In this instance, use the beneficiary’s SSN. All TRICARE beneficiaries have a uniformed services identifi cation card that provides the sponsor’s SSN.
   
• Verify the patient’s address. Because service membersmove or are often in transit, ask beneficiaries to update their contact information during each visit.
   
• Apply accurate coding. Use the Current Procedural Terminology (CPT®) or Healthcare Common Procedure Coding System (HCPCS) codes that most accurately describe the procedure or service. Do not select codes that approximate the service, and avoid using unlisted or miscellaneous codes. When no code exists, it is likely the procedure or service is not covered.
   
• Assign primary and supporting codes. You can avoid claim line denials by assigning primary and supporting codes that denote the reason for the procedure, as well as any diagnosis that affects treatment.
   
• Use proper V codes. A V code can be submitted as the primary diagnosis when it explains the reason for the visit (e.g., a routine child checkup). When submitting a claim with a V code for an ancillary service, list the underlying medical condition as the primary diagnosis. For example, if you submit a claim with the V code for a radiologic exam, you must include a primary diagnosis, such as chest pain, to explain the reason for the X-ray.
   
• Verify important information. Ensure the following information is accurate when submitting your claim:
  • Date of service
  • Patient’s date of birth
  • Rendering provider’s tax identification number
  • Total amount billed

When You Need Assistance
If you discover a problem with a claim, take quick action to resolve it within the TRICARE system rather than sending the issue to collections. PGBA, LLC (PGBA) is your point of contact for resolving claims issues. You can send a secure inquiry to PGBA via the “Ask Us” feature available at www.myTRICARE.com.